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San Antonio Workshops Address Critical Issues.

Editor's Note: Congress attendees continued on their pathways to success Aug. 13-17 with a number of workshops and seminars. Topics ranged from public health and medical-legal issues to special need offenders and infectious diseases. Following are summaries of just a few of them.

Infectious Diseases

With infectious diseases such as hepatitis, HIV/AIDS, tuberculosis (TB) and sexually transmitted diseases (STDs) so prevalent in correctional settings, it is appropriate and timely that the Centers for Disease Control (CDC) presented a workshop on the issue. "Infectious Disease in Corrections: A Centers for Disease Control Perspective" was moderated by Rob Lyerla, an epidemiologist for CDC's National Center for Infectious Diseases.

According to Amy Khan, an epidemiologist for CDC's Hepatitis Division, current data on hepatitis B and C are incomplete and routine screening is not common in the correctional community. Khan noted that inmates have a history of behaviors both inside and outside correctional facilities that make them particularly vulnerable. There is an estimated 1 percent of new cases per year in prisons -- 10 percent greater than in the general population. Thus, inmates are disproportionately infected with hepatitis. "Inmates engage in high-risk behaviors such as unprotected sex, homosexual sex, intravenous drug use and tattooing in prison," Khan said.

Khan pointed out that federal prisons do not provide vaccinations and that only a handful of state systems do. Additionally, there are several missed opportunities for prevention. Khan suggested that correctional facilities establish prevaccination procedures to identify and treat chronic infection. The key to prevention is educating staff and inmates, addressing addiction and considering policy changes, such as the distribution of condoms and bleaching solutions, and the regulation of tattoos.

After 20 years of learning about HIV/AIDS, Karma Krane, an epidemiologist for CDC's HIV Division, says there are still a lot of misperceptions and misinformation that exist in correctional facilities as well as in the general public. "There is no cure for HIV/AIDS," Krane said. Therefore, she noted the need to provide inmates with information about prevention and treatment. According to Krane, 98 percent of STDs can be prevented by the use of condoms. And inmates are 8 percent to 10 percent more likely to be infected with HIV than the general population. "Education is essential to dispel the myths that exist about HIV/AIDS, both within prison walls and on the outside."

Zachary Taylor, an epidemiologist for CDC's TB Division, addressed the audience about the prevalence of TB in corrections. He noted that states such as California, Florida, New York and Texas, which have large inmate populations, have higher rates of TB in their facilities, There is a greater risk of TB for individuals who already have HIV, inject drugs and live in close-quarter environments -- inmates. Taylor used an example to illustrate how quickly TB can be spread in a correctional environment. In 1998, South Carolina began mandating TB testing for HIV-positive inmates. Those with HIV then were segregated from the rest of the population. The males were confined to three dormitories at one prison. In August 1999, an inmate from one dormitory was diagnosed with infectious TB. Within a few months, 31 more cases resulted in that dormitory, some of which occurred after release from prison.

Finally, Marcia Brooks, with CDC's Division of STD Prevention, spoke about STDs. She noted that 20 percent of Americans are infected with STDs. After giving an overview of the symptoms of and myths about syphilis, gonorrhea and chlamydia, she stressed the importance of identifying and addressing risk factors. These include: multiple sex partners, anonymous sex partners, the exchange of sex for drugs, drug use, alcohol abuse and lack of condom use. Among the consequences of untreated or misdiagnosed STD cases are sterility in males and infertility in females, as well as the deaths of unborn or newborn children. Brooks stressed the importance of corrections professionals partnering with CDC in the fight against infectious diseases. "We cannot do our work without each and every one of you."

Hepatitis C -- Problems and Issues for Corrections

Hepatitis C is an ever-growing epidemic in jails and prisons throughout the United States. Several medical and corrections professionals addressed strategies to address this problem during the "Hepatitis C -- Problems and Issues in Corrections" workshop. Speakers included: Daryl T.Y. Lau, M.D., MPH, assistant professor at the University of Texas Medical Branch; Rob Lyerla, Ph.D, epidemiologist of the hepatitis branch of the National Center for Disease Control and Prevention, Centers for Disease Control (CDC); Frederick Maue, M.D., chief of clinical services of the Bureau of Health Care Services, Pennsylvania Department of Corrections (DOC) and John Schaffer of the Bureau of Health Care Services, Pennsylvania DOC.

According to Lyerla, routine testing for hepatitis C should be conducted on people who have used drugs by means of injection, selective medical conditions, a prior transfusion or transplant. He stressed that anyone with a history of drug use via injection should be tested because he or she is a high risk. Each person tested also should receive general information about the disease and prevention. If a person tests positive, he or she should be referred to a support group and receive education on treatment and prevention.

Lyerla pointed out that CDC is working on a variety of plans to help prevent hepatitis C. These plans include integrating hepatitis C into the existing public health infrastructure, expanding lab testing, promoting continuing education, conducting evaluations and finding answers to questions related to the disease's transmission, including cocaine use and tattoos.

According to Maue, inmates should be treated as any other patients. However, the pressing question that remains is: "Should we exceed community standards and test each inmate?" And if we do exceed community standards, what is our reasoning behind it? Although there is not an answer for this, Maue offered some solutions and suggestions on how to deal with the disease by using the Pennsylvania DOC's program as an example. The program's primary goal is managing the disease, reducing legal risks, doing the right thing first and then talking about cost and establishing educational programs for inmates.

Both Maue and Schaffer pointed out the key questions that should be addressed: Who should be screened? Is there enough money? Who should be excluded from the screening? Should genotyping be done? Should liver biopsies be taken? How should inmates be treated? Should mono or dual therapy be used? and How should an educational program be approached?

Maue also pointed out that practical issues must be addressed, such as preparing medical and psychiatric staff for an additional workload.

Pennsylvania also contracted with University Research Associate, Rx Inc., to further help this growing problem. University Research has prepared informational and comic booklets and films, conducts train-the-trainer courses, has brought in speakers for staff, and offers training for all levels.

Although hepatitis C is a continuous problem in correctional facilities, programs such as the one mentioned above and suggestions discussed in this workshop are a step in the right direction to help those who have the disease and to prevent its spread.

Medical-Legal Aspects of Correctional Health Care

According to the Constitution, inmates are guaranteed substantive rights, including the right to access courts; freedom of speech, association and religion; some rights regarding search and seizure and personal property; and the right to health care. Among these rights, health care has been and continues to be a debatable topic among inmates, correctional and medical staff, legislators and the public. Congress attendees had the opportunity to learn and discuss the legal framework for inmate litigation, proper risk management and proper conduct during a lawsuit in the workshop, "Medical-Legal Aspects of Correctional Health Care."

Both Dr. Glenn G. Johnson, correctional consultant of Briar-cliff Consulting in Spicewood, Texas, and Dr. David L. Thomas, health services director for the Florida Department of Corrections (DOC), outlined three musts when it comes to correctional health care -- access to health care, entity to a professional opinion and the right to have that opinion carried out. Johnson noted that it is essential that each institution have some type of 24-hour service for inmates, whether it be round-the-clock nurses or a contract with a local hospital. Emergencies cannot efficiently be taken care of on a 9-to-5 basis. "It is not OK for a person s finger to be cut off and put in the fridge for the weekend," said Johnson.

Johnson also noted that each inmate has the right to a professional opinion. During the 1970s and early 1980s, many medical personnel were not licensed. It is essential for each inmate to be under the care of a competent, licensed doctor or nurse. Once a professional opinion is given, the recommendation must follow through. For example, if X-rays are ordered, they should be taken, Many times, doctors' requests for offenders are not handled -- inmates cannot be denied this right, says Johnson.

With this in mind, corrections and medical personnel also should be aware that despite the fact they have the option of deciding who is in charge of their institution's health care, they are fully responsible for their facility, no matter with whom they contract. In addition, medical personnel should have the policy of informed consent in which an inmate is informed of his or her condition through a detailed oral explanation.

Thomas offered several suggestions for running an efficient prison health care system by using examples from the Florida DOC. These suggestions included educational programs for inmates so they can learn about their health conditions and consolidating inmates according to their diseases. "This is not segregation," says Thomas. "We are placing people with similar medical needs in facilities so they can be treated properly."

Thomas also warned about investigational studies. He cited a 1982 salmonella study in which inmates were injected with a significant amount of salmonella under coercion. He also warned about overt coercion, for it can cause an inmate physical, social and/or psychological harm.

Both Johnson and Thomas say that in order to have a successful health care system in your institution, you must treat an inmate like any other patient -- listen to them, respect them, be fair, and make sure all requests are carried out.

Can Criminal Behavior Be Changed?

Although there is evidence that disputes the "nothing works" theory, correctional agencies constantly are faced with the challenge of proving criminal behavior can be changed. "Can Criminal Behavior Be Changed?" presented the problems correctional agencies face when trying to prove behavior can be changed. The session offered valuable suggestions and solutions to help agencies. Part 1 discussed the need for a standardized process for returning offenders, training for parole counselors and program modification. It also stressed the importance of gathering and comparing information and finding out what programs work so they can be continued or established elsewhere. Part 2 discussed the results of a survey conducted by the American Correctional Association's (ACA's) Research Council and focused on how to establish effective partnerships between researchers and correctional practitioners.

Part 1

Dr. John E. Berecochea, chief of the Office of Research for the DOC in Sacramento, Calif., said, "Criminals do think differently. If you can fix that thinking, then maybe you can stop that behavior." Fixing this thinking can be done by developing efficient, effective programs that are objective, establishing standards for returning offenders to the community and training parole officers. He also noted that modification and standardization are key to successful programs. Berecochea stressed the importance of research in order to find out what programs work. He referred to a study done in the California correctional system that showed inmates in boot camp reoffended just as much as those who did not attend boot camp. He also spoke of a structured prison work program that made second-time offenders do menial, unrewarding, hard labor. Studies showed too, that inmates in this program reoffended as well.

Meesim C. Lee, branch chief of the Division of Resource and Information Management of the DOC in Columbia, S.C., said information systems allow for better management and programs. Gathering information, comparing data and finding out what programs work are important aspects of research.

Bill Woolie, chief of work force development for the DOC in Tallahassee, Fla., has found that in order to provide effective programs, information research is extremely important. Research that has proved the success of vocational programs in Florida was brought to legislators. In turn, the programs in the system have grown from 110 to 175 in one year. Woolie further said that research is important for establishing and continuing programs that work or for ending unsuccessful programs. "You can say all you want and provide it, but it still is not going to work if inmates do not want to do it."

Dr. Larry Motiuk, director general of the research division for Correctional Service Canada in Ontario, stressed the importance of research as well, and said targeting an inmate's and agency's needs and assessment, design and development of a program is essential.

Part 2

Voncile Gowdy, senior social scientist at the National Institute of Justice (NIJ) spoke about the Corrections Partnerships Program, in which NIJ partnered with correctional agencies throughout the nation to enhance correctional practitioners' abilities to accomplish duties and establish effective programs. The purpose and goals are to identify research contacts for correctional agencies, determine the structure and responsibility of research units, outline foci and priority of research topics and summarize obstacles in conducting research. Gowdy said the most important aspect of partnerships is to build open communication and trust, "When forming them, you must identify your expectations, composition and outcome and identify who will support them and if there will be lasting relationships," she said.

In order to find out more about research methods in correctional agencies, the ACA Research Council conducted a National Corrections Research Project that resulted in an extensive survey and article published in Corrections Compendium, a listing of research contacts, presentation materials and ultimately, better communication. Daniel Storkamp, director of the Interagency Management Unit at the DOC in St. Paul, Minn., and Richard Tewksbury, associate professor of justice administration at the University of Louisville in Louisville, Ky., presented the project. Both, along with the Hon. Helen Corrothers and Dr. Frank Porporino, created the project as well. The survey focused on how many facilities have research units, what are the research unit budgets and staffing comprised of, the units' responsibilities and tasks, the current topics being researched and the obstacles agencies experience when conducting research. Results and findings can be found in the August 2000 issue of Corrections Compendium.

Corrothers, chair of the ACA Research Council and commissioner of the U.S. Sentencing Commission, concluded the session with an insightful comment: "The use of research has become increasingly important, especially since we are heading toward having almost 7 million people in correctional custody," she said. "We need to find out why we have so many people incarcerated, how it can be stopped, what programs are working and what programs are failing. The only way to get this proof is through research."

DNA Decoding

Now, thanks to DNA technology, DOCs, jails and law enforcement agencies can access offender DNA information that is stored in a national database. In "DNA Decoding: National Electronic Access Through the CODIS Program," presenter Samuel Baechtel, Ph.D., of the FBI, Laboratory Division, DNA Analysis Unit, shared with the audience an overview of the FBI's use of technological improvements in DNA decoding as well as the CODIS program.

According to Baechtel, the probability of randomly matching someone's DNA is 1 in 16 million. When investigating a crime, the FBI first determines a DNA profile and then determines how often that particular profile occurs. One human cell contains nearly 6 feet of DNA and about 100,000 genes. One's DNA pattern is fixed at the moment of conception and that pattern does not change throughout one's life. "We now have the great ability to distinguish one person from another through genes," Baechtel sald. "This is the value of DNA profiling."

DNA evidence can be gathered from blood, saliva, semen, perspiration, urine, vomit, bones, teeth and hair. It also can be collected from objects such as clothing, cigarette butts, licked stamps and envelopes, ear plugs, bottles, glasses and telephone receivers.

After DNA is extracted, Baechtel said, no matter how small the sample, duplications are made in the laboratory through "molecular Xeroxing." Areas that have been determined to contain information are targeted. Finally, the DNA is typed.

DNA typing was first used in labs in 1988. At that time, DNA had to be intact and large samples were necessary. Now, due to the evolution of this technology, very small samples can be used and much testing is computerized. According to Baechtel, DNA evidence now is such a powerful tool that it can be used to solve a murder even when nobody is found. The main difficulty, he said, is that the number of cases are difficult to manage, resulting in a backlog. Baechtel currently oversees more than 150 cases, as do his colleagues. He noted that this year, Congress has appropriated $15 million for offender backlogs. A new FBI lab in Quantico, Va., also is planned for 2002.

Through CODIS, information can be gathered that can link offenders to other crimes. As of Feb. 1,1,116 crimes in 28 states have been linked to offenders in the database. "It pays off. It really does," Baechtel said. Currently, the database includes more than 330,000 offender DNA profiles and more than 17,300 forensic profiles (evidence from cases already worked on). Baechtel noted that the FBI's Criminal Justice Information System is linked to every state in the country. In addition, several international labs have joined CODIS. By the end of 1998, all states had enacted legislation to collect offender DNA samples. However, not all states have actually collected them yet.

In the future, Baechtel said, crimes need to be reported to police quickly, followed by the performance of forensic analysis. Also, statutes of limitations must be adjusted so that DNA technology that was not previously available can be used to prosecute suspects of older crimes.

The use of DNA evidence is becoming more prevalent in helping to solve criminal cases. Because of its sophistication and level of accuracy, it now is being introduced in previously adjudicated court cases and is causing decisions to be reversed in which suspects have been found guilty.
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Author:Clayton, Susan; Klug, Elizabeth
Publication:Corrections Today
Geographic Code:1USA
Date:Oct 1, 2000
Previous Article:San Antonio Offered Pathways to Success.
Next Article:Opening Session Keynote Address.

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